The aim of this study was to evaluate the correlation between various anthropometric parameters and the graft diameter of the peroneus longus tendon (PLT).We retrospectively analyzed the data of 156 patients who underwent anterior cruciate ligament reconstruction (ACLR) with the PLT graft at our institution. Anthropometric parameters, including height, weight, gender, age, duration of injury, and preinjury activity levels, were recorded. t tests, correlation coefficients (Pearson r), and a multiple linear regression analysis were used to evaluate the influence of these anthropometric variables on the diameter of the graft obtained.The mean PLT graft diameter was 8.3 mm, and 21 patients (13.5%) had a diameter less than 8 mm; 85 patients (54.5%) had a diameter between 8 and 9 mm, and 50 patients (32.0%) had a diameter greater than or equal to 9 mm. The correlation analysis showed that height (P < .001), weight (P < .001), and duration of injury (P = .012) were significantly related to graft diameter. On the basis of these 3 predictors, the following regression equation was obtained: Diameter = 2.28 + 0.028∗height (cm) + 0.013∗weight (kg) + 0.289∗duration of injury (0 or 1). Patients who were short and shin were more likely to own smaller graft diameters (<8 mm), especially the one ruptured his or her anterior cruciate ligament (ACL) over 3 months.Height, weight, and duration of injury were associated with the diameter of PLT. They are important preoperative information for surgeon about the size of PLT and can be used for alternative graft source planning and patient counseling.Level of evidence: IV

Background: Intraarticular injection of the mesenchymal stem cells (MSCs) has shown to be successful for treating osteoarthritis (OA). Nevertheless, many studies have been focusing on autologous MSCs. The following study investigates the safety and effectiveness of intraarticular injection of allogenic MSCs in a pig OA model. Methods: Superparamagnetic iron oxide (SPIO) nanoparticles were labelled with bone marrow-derived mesenchymal stem cells (BM-MSCs) to allow cells tracking using magnetic resonance imaging (MRI). A pig OA model was established by bilateral medial meniscectomy. Next, SPIO-BM-MSCs were injected into the right knee, while the left knee was left untreated. MRI and radiography were used to assess the degree of OA and to evaluate the effectiveness of allogenic MSCs. Hematoxylin and eosin (H&E), safranin-o fast green staining, toluidine blue, and immunohistochemical staining were used to evaluate the therapeutic effect of the injections. Results: At concentration of ≤20 μg/mL, SPIO caused no toxicity to BM-MSCs. Four weeks after surgery, OA changes were observed on MRI scan. The SPIO labeled BM-MSCs were found moving towards the impaired part of the cartilage 8 to 24 h after injections. In addition, no significant differences between the right side (therapeutic side) and the left side (untreated side) were observed following histological and immunohistochemistry analysis. Conclusions: The suitable concentration of SPIO for labelling BMSCs was 20 μg/mL, while the allogenic MSCs could move towards and accumulate around the impaired cartilage. No significant difference was found between treatment and control group.

Hypertensive patients are more likely to experience latent cerebral ischemia causing regional cerebral oxygen saturation (rSO) decrease during general anesthesia. The aim of this prospective observational study was to assess the incidence of decreased rSO in hypertensive patients undergoing major abdominal surgery and the perioperative factors affecting this change in rSO. A total of 41 hypertensive patients were enrolled and stratified according to their hypertension as controlled and uncontrolled. The intraoperative rSO and physiological data were routinely collected. The Mini-Mental State Exam (MMSE) was used to test cognitive function before surgery and after 4 days. Cerebral desaturation was defined as a decrease in rSO of more than 20% of the baseline value. There were 20 patients (49%) suffering intraoperative cerebral desaturation classified into cerebral desaturation group (group D) and those 21 without intraoperative desaturation classified into normal group (group N). The area under the curve below 90 and 80% of baseline (AUC and AUC) was lower in patients of group N (2752.4 ± 1453.3 min% and 0.0 min%) than in patients of group D (6264.9 ± 1832.3 min% and 4486.5 ± 1664.9 min%, P < 0.001). Comparing the two groups, the number of uncontrolled hypertensive individuals in group D (12/20) was significantly more than group N (4/21) (P = 0.007). A significant correlation was observed between relative decrease in MAP and relative decrease in rSO (r = 0.495, P < 0.001). Moreover, nine patients (45%) in group D occurred early postoperative cognitive function decline were more than three patients (14.3%) in group N (P = 0.031). This pilot study showed a large proportion of hypertensive patient experienced cerebral desaturation during major abdominal surgery and uncontrolled hypertension predisposed to this desaturation. NCT02147275 (registered at http://www.clinicaltrials.gov ).

Background Hypokalemia is a common form of electrolyte disorder, which has a higher incidence in hospitalized patients and is closely related to perioperative complications and prognosis. Due to decreased skeletal muscle mass which causes total body potassium reduction, and increased comorbidities, the elderly are more susceptible to hypokalemia. Objective To investigate preoperative hypokalemia in elderly patients and its effect on postoperative complications. Methods Data were retrospectively collected from the elderly patients who underwent elective surgery from April 2018 to March 2019 and had preoperative blood gas data available. Patients, with age 60 to 100 years, were divided into hypokalemia group (potassium level < 3.5 mmol/L) and normokalemia group (potassium level between 3.5 and 5.5 mmol/L) according to preoperative blood gas analysis. Hypokalemia can be divided into mild (potassium level 3.0 to 3.5 mmol/L), moderate (potassium level 2.5 to 3.0 mmol/L) and severe (potassium level < 2.5 mmol/L), respectively. The risk factors of preoperative hypokalemia and its impact on postoperative complications and prognosis were primary outcomes. Secondary outcomes included postanesthesia care unit (PACU) stay time and hospital length of stay (LOS). Results Of 987 participants, 436 (44.17%) developed preoperative hypokalemia, among them 357 (81.88%) mild, 87 (16.74%) moderate and 6 (1.38%) severe. Multivariate logistic regression showed that female gender (OR, 1.851; 95% CI, 1.415–2.421), pre-existing hypokalemia at admission (OR, 4.498; 95% CI, 2.506–8.071), and oral laxative twice or more (OR, 1.823; 95% CI, 1.266–2.624) are risk factors of preoperative hypokalemia. Gynecological and biliopancreatic surgery were more common in hypokalemia group than normokalemia group (P <  0.001, P <  0.05). There was no significant difference in postoperative complications, PACU stay time, LOS, and 30-day mortality between the two groups (all P >  0.05). Conclusions Female gender, pre-existing hypokalemia at admission, and oral laxative twice or more are independent risk factors for preoperative hypokalemia in elderly patients. However, postoperative complications and 30-day mortality were not increased, which may be related to monitoring blood gas analysis and prompt correction of potassium levels during surgery.

The intraspinal enterogenous cyst, also called an neurenteric cyst, is a rare congenital disease. It was reported to be local to the C1 to L2 spinal segments, with the majority located in the cervicothoracic region. Most patients present with symptoms of progressive focal pain, myelopathic signs or radicular symptoms. We report a rare case of thoracic spinal intradural extramedullary enterogenous cyst with rapidly progressive weakness of both lower extremities. Additionally, we analysed the literature concerning the clinical features, diagnosis and prognosis of this disease.